急診留觀患者超過48小時原因分析

An Analysis of the Reasons for Patients Staying over Forty-eight Hours in an Emergency Department Observation Unit

何世傑(Sai-Kit Ho) ； 阮祺文(Chi-Wen Juan) ； 林月招(Yueh-Chao Lin) ； 許維尹(Wei-I Hsu) ； 侯秀慧(Hsin-Hui Hou) ； 周志中(Chu-Chung Chou)

《The Changhua Journal of Medicine》 6卷4期 (2001/10) Pp. 235-245

摘要

本研究旨在探討急診病房患者留觀超過48小時之病患人口學、患者、護理人員、醫師及醫院政策等方面之影響因素，研究工具採自擬之結構性記錄表，調查期間自民國88年3月1日起至88年4月1日止，共完成觀察訪問277人，有效樣本223人。結果顯示：研究樣本年齡以60歲以上居多佔48.4%，性別則以男性居多(53.8%)，疾病別以內科(76.7%)為主，留觀超過48小時者佔32.7%。經邏輯式複迴歸分析發現：主要影響因素為醫師判斷是否應繼續留觀及其與患者是否自覺症狀未改善之交互作用。即醫師判斷繼續留觀且患者自覺症狀未改善者，其留觀超過48小時之機率較高。因醫師判斷的個別差異無統一標準，建議應該訂定出入院標準供醫師參考，並發展患者健康照護與知識訊息之增強，以增強患者對疾病的認知與自我照顧能力。以期降低本院患者留觀超過48小時之比率。

關鍵字

觀察時間 ； 觀察室

並列摘要

The aim of this study was to survey the demographic profile of patients, and the effects that medical and nurse staff, and hospital policy had on patients staying over 48 hours in the observation unit of a medical center in central Taiwan.
A total of 277 questionnaires were returned; the study was carried out during a one-month period. The effective sample was 223 questionnaires entered into a computer database and the data was evaluated by logistic complex regression analysis. The contributing factors of the sample for long-term stay were older than 60 years old (48.4%), male gender (53.8%) and medical problems (76.7%); 32.7% of patients stayed longer than 48 hours. The reasons for long-term stay were: (1) variations in decisions taken by different doctors, (2) the symptoms not totally resolved within 48 hours, and (3) the time spent in patient education to enforce self-care knowledge.
The results of this survey suggest that concerns regarding patient and medical staff need to be addressed in Taiwan through continuous education to decrease the observation period.

並列關鍵字

observation time ； observation unit